November is National Epilepsy Awareness Month, making it an ideal time for providers and patients to learn more about the tools used in diagnosing the condition. Magnetic resonance imaging, or MRI, is one imaging tool often used when investigating potential epilepsy. MRIs help quickly rule out or identify physical causes within the brain for seizure activity, supporting the development of the most appropriate treatment plan.
What is MRI epilepsy protocol
MRI epilepsy protocol refers to the sequence of images taken of the brain when evaluating a potential seizure disorder. While best practices do exist, protocol design varies according to factors that include:
- The needs of the patient and the specifics of the symptoms and case
- The MRI equipment being used
- The preferences of the radiologist, doctor and facility involved1
The ability to customize MRI epilepsy protocols to the needs of the situation is a benefit and one reason the technology is a top choice among providers who treat seizure disorders.
The accuracy of MRI in epilepsy diagnostics
When conducted by experienced, knowledgeable providers, MRI protocols can be extremely accurate in understanding the root cause of and diagnosing certain types of epilepsy. Scan results are quite adept at pin-pointing potential physical causes for symptoms, such as scarring on the brain or tumors.2 However, not all epilepsy has a physical cause that shows up on scans. In some cases, providers may use the scans to view brain activity instead, looking for trends that might explain seizures.
MRI is so accurate in these endeavors that the National Institutes of Health has previously suggested that it could be used in a program not just to identify existing epilepsy but to identify the potential of epilepsy in the future. The NIH notes that childhood fevers can lead to seizures, which are typically benign. But when those seizures are prolonged, it can be an indication of a risk for epilepsy in the future. The NIH notes that MRI, combined with EEG, can help identify biomarkers to determine when children may be at risk so preventative measures can be developed.3
MRI as a presurgical evaluation tool
Accuracy does depend on the correct MRI protocol, especially when doctors are looking for a deeper understanding of epilepsy in preparation for potential surgical interventions.
Standard MRI examinations don't always display relevant epileptogenic lesions.4 These are lesions or areas of the brain where seizure activity begins.5 When these lesions can be appropriately identified by brain scans, surgical teams may be able to evaluate them for removal. If you remove where the seizure starts, you often remove the seizures. MRI protocols specifically for epilepsy help ensure a more accurate look at these factors, better supporting surgical outcomes for epilepsy.
Certain types of MRI machines are better at this task than others. The 3.0T MRI, for example, provides a better image quality than 1.5T MRI when it comes to detecting and defining these lesions.6 It's not always the exact piece of machinery that's important, though. Radiologists must know how to set up scans for epilepsy protocol, and both human providers and computers capable of interpreting the results are necessary to the process. When all of these measures come together, MRI results can be used by operative teams to make decisions that:
- Help ensure surgeries are a success in treating epilepsy
- Protect patient brain functionality
- Support faster post-operative recovery times
Other benefits of MRI
MRI is a noninvasive approach to investigating epilepsy. Real-time fMRI is even taking the place of more invasive procedures that stimulate brain areas to test for responses that might indicate seizure disorders.7 With imaging taking a guiding role and reducing immediate need to turn to invasive diagnostics, patients are able to get answers quicker and with less risk.
MRI protocols can often be completed in around 30 minutes, reducing the anxiety and discomfort patients might feel with longer diagnostic procedures. Plus, there's no need for medication or anesthesia and almost minimal risk of infection or side effects from MRI procedures.
Magnetic resonance imaging certainly has a place in epilepsy diagnostic and treatment procedures. Patients who believe they might be experiencing seizure disorders can talk to their doctor about the risks of epilepsy and potential diagnosis involving MRI techniques.
1. Daniel J. Bell and Bruno di Muzio. "Epilepsy protocol (MRI)." Radiopaedia. Web. 6 November 2018. <https://radiopaedia.org/articles/epilepsy-protocol-mri>.
2. "Brain Scans For Epilepsy." epilepsysociety.org Web. 6 November 2018. <https://www.epilepsysociety.org.uk/brain-scans-epilepsy#.W-GEx5NKjIU>.
3. "MRI and EEG could identify children at risk for epilepsy after febrile seizures." NIH.gov Web. 6 November 2018. <https://www.nih.gov/news-events/news-releases/mri-eeg-could-identify-children-risk-epilepsy-after-febrile-seizures>.
4. J. Wellmer, et al. "Proposal for a Magnetic Resonance Imaging Protocol for the Detection of Epileptogenic Lesions at Early Outpatient Stages." Epilepsia. 6 November 2018. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189636/>.
5. H. Urbach. "The Term “Epileptogenic Lesion” and How to Use it." Medical Radiology. 2013. Springer, Berlin, Heidelberg. 21-23.
6. Lucas Giasante Abud, et. al. "Partial epilepsy: A pictoral review of 3 TESLA magnetic resonance imaging features." Clinics (San Paulo). 2015. Web. 6 November 2018. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557590/>.
7. Kesavadas Chandrasekharen and Thomas Bejoy. "Clinical applications of functional MRI in epilepsy." Indian Journal or Radiology and Imaging. Web. 6 November 2018. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747426/>.